Discharge after Reduction of Intussusception Is Safe and Effective

This is Alex Gibbins from Akron Children's Hospital, and here's your video review. The article I'll be discussing today is entitled Emergency Department discharge following successful radiologic reduction of ileocolic intussusception in children, a protocol-based prospective observational study. This study came out of Children's Mercy Hospital in Kansas City with Joseph Sushka as the first author, and Shawn St. Peter as senior author. The rationale behind this study was that previously, the hospital had a protocol in place wherein all patients who had reduction of intussusception were admitted for observation in order to rule out recurrence. However, the authors felt that due to the low rate of recurrence in this patient population, they could be safely managed as outpatients. Therefore, they developed a new protocol and compared their outcomes from the 115 patients after implementation of the protocol to the 90 patients prior to its adoption. Any patient with a diagnosis of intussusception received a surgical consult. If they had peritoneal signs, they were taken to the operating room immediately. Otherwise, they underwent air contrast enema for attempted reduction. If the intussusception was unable to be reduced after three attempts, they were taken to the operating room. If the reduction was successful, they were observed in the ED for four hours. If they had no recurrent symptoms during this stay, they were discharged home. If the symptoms did return, they had repeat ultrasound and repeat enema if the intussusception had returned. All patients who required repeat reduction were admitted for observation. When comparing the two groups, the authors found no difference in the rate of successful enema reduction, the rate of operative intervention, the rate of recurrence, or readmission within 30 days. However, in the post-protocol group, they noted that there was a decrease in admission by 66%, and that the length of stay was reduced by 15 hours. On the other hand, in the post-protocol group, they noted that there was an increased rate of return to the emergency department within 30 days, and that there was a shorter time frame from discharge to return to the ED. However, again, this did not result in an actual increased readmission rate. Therefore, the authors were able to conclude that after successful reduction of intussusception, children can be observed in the emergency department and then discharged home if they have no recurrence of symptoms. It's great review. I'm glad you chose this study because I think this is something a lot of people have been talking about, and now we actually see what happens when you put the protocol into play. So what they found is once they instituted this new protocol, they reduced their admission rate from 100% down to 33%, and they reduced their total length of stay by 15 hours. Right. And there were no morbidities or major complications from doing this new protocol. Uh so overall, this it may be the start of a trend around the country of sending these patients home. I'm curious if this would change people's management in their hospital. Are you already sending your patients home? And if not, would this study convince you that maybe now you can institute this same protocol? Leave your comments and questions below. We'll see you next time. Thanks.